EX-99.(A)(3) 4 a2053248zex-99_a3.txt EXHIBIT 99.(A)(3) Exhibit (a)(3) CASELLA WASTE SYSTEMS, INC. ELECTION FORM Pursuant to the Offer to Exchange Dated July 2, 2001 / / I wish to offer for exchange the option listed below where I have placed an "X" in the box corresponding to that option. I understand that if my offer is accepted I will receive a new option to purchase one share of common stock for every two shares of common stock issuable upon the exercise of a surrendered option, as more fully explained in the Offer to Exchange.
NUMBER OF SHARES CHECK BOX IF PLAN UNDER WHICH EXERCISE ISSUABLE NEW NUMBER OF YOU WISH TO ELIGIBLE OPTION PRICE OF UNDER SHARES ISSUABLE OFFER THE OPTION WAS GRANT DATE OF ELIGIBLE ELIGIBLE UNDER NEW BELOW FOR EXCHANGE GRANTED ELIGIBLE OPTION OPTION OPTION OPTION* -------------------- ----------------- --------------- --------- ---------- ---------------- / /
* The exercise price will equal the closing price of our Class A common stock as quoted on the Nasdaq National Market on the new grant date. Each new option will be issued under the Casella Waste Systems, Inc. Amended and Restated 1997 Stock Incentive Plan. / / I do not wish to offer for exchange any eligible options. Please complete and sign this form and return it to Priscilla Hughes or Mary Mullin with each option agreement you are seeking to exchange for new options. Date: , 2001 ------------------------------------------------ -------------- Signature ------------------------------------------------ Print Name THIS FORM MUST BE RECEIVED BEFORE 12:00 MIDNIGHT, RUTLAND, VERMONT TIME, ON JULY 31, 2001.